Abstract
BackgroundChronic kidney disease (CKD) is highly prevalent in patients with coronary artery disease (CAD).ObjectiveThe outcome following revascularization using contemporary technologies (new-generation abluminal sirolimus-eluting stents with thin struts) in patients with CKD (i.e., glomerular filtration rate of < 60 mL/min/1.73m2) and in patients with hemodialysis (HD) is unknown.Methodse-Ultimaster is a prospective, single-arm, multi-center registry with clinical follow-up at 3 months and 1 year.ResultsA total of 19,475 patients were enrolled, including 1466 patients with CKD, with 167 undergoing HD. Patients with CKD had a higher prevalence of overall comorbidities, multiple/small vessel disease (≤ 2.75 mm), bifurcation lesions, and more often left main artery treatments (all p < 0.0001) when compared with patients with normal renal function (reference). CKD patients had a higher risk of target lesion failure (unadjusted OR, 2.51 [95% CI 2.04–3.08]), target vessel failure (OR, 2.44 [95% CI 2.01–2.96]), patient-oriented composite end point (OR, 2.19 [95% CI 1.87–2.56]), and major adverse cardiovascular events (OR, 2.34 [95% CI 1.93–2.83, p for all < 0.0001]) as reference. The rates of target lesion revascularization (OR, 1.17 [95% CI 0.79–1.73], p = 0.44) were not different. Bleeding complications were more frequently observed in CKD than in the reference (all p < 0.0001).ConclusionIn this worldwide registry, CKD patients presented with more comorbidities and more complex lesions when compared with the reference population. They experienced higher rate of adverse events at 1-year follow-up.Graphic abstractOne-year summary outcomes of contemporary PCI in renal insufficiency. CKD chronic kidney disease, POCE patient oriented composite endpoint, MACE major adverse cardiovascular events, TLF target lesion failure, TLR target lesion revascularization, ST stent thrombosis
Highlights
Chronic kidney disease (CKD) is highly prevalent, affecting more than 1.5 million patients in Europe and the USA and represents one of the most frequent comorbidities in patients with coronary artery disease (CAD) [1,2,3,4]
We aimed at evaluating the outcomes following revascularization using contemporary technologies in patients with CKD including a subgroup of patients undergoing hemodialysis (HD) in the prospective, singlearm, multi-center, international e-Ultimaster registry
Previous studies on revascularization have shown that patients with CKD after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are at increased risk of death and adverse events, correlating with the severity of renal insufficiency [23,24,25]
Summary
Chronic kidney disease (CKD) is highly prevalent, affecting more than 1.5 million patients in Europe and the USA and represents one of the most frequent comorbidities in patients with coronary artery disease (CAD) [1,2,3,4]. Adverse event rates following PCI and CABG were significantly higher in CKD patients when compared to patients with normal renal function [5,6,7,8, 14,15,16]. We aimed at evaluating the outcomes following revascularization using contemporary technologies (abluminal sirolimus-eluting stents with thin struts) in patients with CKD (defined as an estimated glomerular filtration rate of < 60 mL/min/1.73m2) including a subgroup of patients undergoing hemodialysis (HD) in the prospective, singlearm, multi-center, international e-Ultimaster registry. Conclusion In this worldwide registry, CKD patients presented with more comorbidities and more complex lesions when compared with the reference population They experienced higher rate of adverse events at 1-year follow-up
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